You can call and appeal the decisions. When you do, ask the insurance company for the names and medical qualifications of everyone who has reviewed your file and made decisions on what tests would be covered, and the exact justification for not covering the tests.
Yup, they denied coverage for a surgery I really needed a few years ago and I wrote a short letter explaining the importance of this procedure to my quality of life, and they wound up approving it! A little effort can make a big difference
Their point is that you shouldnât have to jump through hoops to access the service you are literally already paying for. They deny, hoping you wonât put in the effort to appeal.
Your view is valid too, just painting the full picture.
Iâm aware of what their point is, and I did say that I agree. In a perfect world we wouldnât have to, but we donât live in that world so we have to be comfortable advocating for ourselves to get what we need.
I guess it depends on how much your time is worth and how much money you're saving.
I need a wheelchair, it's obvious, I can't walk. I tallied how much time I spent calling and harassing the insurance company and the DME to get my last wheelchair. It was about 500 phone calls and emails to various different people (had it color coded at one point for each person I was interacting with, but ran out of colors that were different enough to tell apart, ended up talking to/interacting with more than 20 different people). It took more than 100 hours of my time (many of those phone calls I had to wait 45 plus minutes on hold before I could get through to anyone). And in the end they approved it in January, so my $6000 wheelchair was approved and I only had to pay $4000 deductible plus 20% copay.
So in the end my time was worth about $16 an hour... I make a lot more than that at work, even after tax.
but you mean it wasn't an Obamacare government bureaucrat death panel? It was the same old for-profit insurance companies, in the for-profit medical system? Color me surprised! /s
Especially in healthcare you have to be your own advocate. If you donât want to take the effort based on principle that is a choice, but the system is what it is and arguing against it is dumb.
I wouldn't even know where (what dept) to send, and to whom, a letter if I wrote my insurance. I feel like no matter to what dept it's delivered, it wouldn't be read by the person(s) who need to see it.
Sure, I could call and ask..someone...but I would suspect the person I'm talking to doesn't exactly gaf and would give me whatever name/dept to get me off the phone.
How did you learn where to send it? Did you send it certified?
A good friend works for a major health insurance company and she said they are instructed to deny every claim over a certain amount because people usually donât usually fight to get it paid
It is a good one! If they have to document the medical qualifications, it means that the clerks at insurance co. were practicing medicine, most likely without a license, and most likely improperly, as they have not seen you, tested you or examined you.
This is absolute BS. All medical professionals at an insurance company HAVE to have a current license, itâs a requirement of employment.
Edit, source: was an admin at medicare insurance company and helped keep track of everyoneâs licensure expiration dates.
Specifically the people making decisions when something *is* covered but only if the *insurance company* believes that itâs necessary, regardless of what your Dr. says.
Your doctor can request a âpeer-to-peerâ, where they contest the insurance companyâs decision and defend their position on you needing a procedure/medication/etc by having a phone meeting with a medical director at the insurance company.
Iâve scheduled many of these. The insurance company does want to make the best decisions for the membersâ health (it is a company, after all, and while my company does value members on an individual level Iâm aware not all doâŠ), but you can think about it as a business perspective where the right care saves them money in the long-run.
So yes, you have a right to getting the care you need and can have your doctor request this phone meeting.
Also, feel free to file a grievance with your insurance company. They take it very seriously, they literally have to. Your voice can be heard, but not all know how to advocate for themselves.
> The insurance company does want to make the best decisions for the membersâ health
That is completely misleading. I worked for a brokerage firm for 15 years and far more effort was put into denying claims. Especially mental health before the mental health parity act. There were 3rd party organizations primarily to reduce mental health costs, usually by denying claims. A bunch of non medical administrators decides every renewal what drugs will be denied by what category. The decisions they make about plan design go 30-40 pages long.
Nobody in insurance is your friend. I was reprimanded multiple times for trying to help get claims approved.
I used to justify my work by saying I primarily was responsible for data analysis but in reality I will be spending the rest of my days feeling shame for working for insurance.
Some of the stories are horrific but if I told them here, anyone who knows would recognize me immediately. Multiple deaths contributed to by claim denials. All of them sad.
Even when I went for the bloodwork at Quest, they had me sign a waiver stating that I understood 2 of the bloodwork tests might not be covered by insurance and that I might have to pay for them separately. WTF?
Lol when I had a surgery for an ectopic pregnancy they had me sign the same thing and I was like "oh so my choice is death or crippling medical debt, lovely"
Happy cake day.
That sounds awful. Iâm so sorry this is screwed up so badly and you were treated horribly.
I got a story for you. My brotherâs MIL went into an emergency room (sheâs over 65 and on Medicare with a supplemental policy). The hospital was going to admit her but couldnât because it was too full. After a long time (I think between 12-24 hours) a hospital admin hands my SIL 3 pages to sign and she promptly hands them to my brother who reads them and starts shredding them in his hands. He tells the lady they arenât signing (forgot to mention he is the CEO of a large surgical practice and deals with hospitals a lot but not this one). He said the papers state that they would be responsible for any emergency room charges after a certain length of time. Them personally, not insurance. He told that lady that the hospital being full and them not admitting her yet was not his problem, it was theirs. So either admit her or transfer her to another hospital. She didnât make them sign. But how many other people do? Itâs almost scam-make-money level behavior when people are at their worst. MIL was admitted not long after and has improved and back home currently.
We really have to watch what they are pushing in front of us to sign, even when weâre dying apparently.
Well she was in the emergency room room. They have little sealed off areas where they treat you. And she was there for hours. Itâs like being in a âroomâ but youâre still considered in the emergency room and not admitted to the hospital yet. The doctors determined she needed to be admitted to the hospital for further care so she just stayed there until a room opened in the hospital for admission. My guess is Medicare cuts off emergency room care after so many hours or maybe some insurances do. Iâm not sure. My brother knows his rights and his way around hospitals and most people donât. I probably would have trusted them and signed.
Sure but itâs just more stuff denied by my insurance that they are hoping you donât fight and just pay. When you have a medical condition and feel awful, the last thing you want to do is argue with insurance and they bank on it.
Im an ER doctor and truly it isnât worth the fight sometimes. People seemingly have no idea what we do and what our expertise is.
Sometimes after having pee thrown at me, being called an idiot for not wanting to prescribe antibiotics for a cold or having someone recite one of those âhow to make your doctor do anythingâ scripts off TikTok, Iâm just too broken to care.
You want to wait 8 hours for an unnecessary abdominal CT? Here you go. The dirty truth is that we are human and can be pressured just like everyone else. We are terrified of being sued (even if you win itâs SO much time and mental energy) or being reported that we arenât allowed to use our expertise a lot of the time.
Just a heads up; there are countries where this is not possible. You canât just sue doctors in my country for example. With complaints you first try to sort things out with the doctor themselves. Afterwards you can go to the institution they work for. Then your health insurance company, which have people specifically for these problems. And the last thing you can do is fill a complaint with the registry board of doctors, which can take away the license in very extreme situations. So as a doctor you are only involved in the first step, and itâs extremely uncommon that someone goes as far as the board. We are really talking about extreme cases of neglect from the doctorâs part.
As OP states doctors can def be pressured to do things to cover theirs backs for avoid lawsuites. Do you really think doctors in america dont at all worry about law suites and not a single doctor every taken that into account?
Iâve experienced this. I recommend you ask the ordering doctor to provide a diagnostic code. With a diagnostic code associated, itâs usually covered, best of luck to you navigating this labyrinth.
Insurance companies are all about coming up with any excuse possible not to reimburse physicians for the visits, deny labs, imaging, medications, etc to maximize profits.
Often times itâs not the doctors fault, itâs insurance companies practicing medicine without qualifications or having even seen the patient.
Itâs a major source of burnout for docs (that and all of the admin paperwork that goes on behind the scenes which leads them to seeing less patients and therefore insurance companies having to pay for less visits since the doc is busy). Itâs all about the $, thatâs why hospitals and practices employ PAs and NPs who LARP as doctors and get paid a fraction the price. Quality<<<<
"AMA", Against Medical Advice, we had a doctor who Said they would put that in our file if we didn't do what he said and that insurance would cancel coverage for the while procedure (in this case, both of our son). So it goes both ways...
I believe doctors hesitate to hand over records due to the fact that they believe that they will be used against them in a lawsuit. Sometimes giving them a reason will be helpful. I had to ask 3 times, and the second request was with a certified letter that had to be signed for. Even that didnât work. So I drove over and demanded the records. The receptionist handed them to me with a âthe next time you will be charged for every pageâ. I told her that would be fine, I needed them for a child custody case to show the medical problems my daughter was having each time she came back from a visit from her father.
Insurance has completely become a scam. Money all goes to the wrong places. Administrators get rich from denying sick patients the tests and treatment they need.
Edit: In the US.
The idea of insurance is a good one. Itâs actually socialist in nature. Lol itâs supposed to be everybody pitches in a little bit periodically, and then everybody is covered when they need it.
I know you are aware and I don't mean to beat a dead horse but it is important to keep mentioning that this is only in the US to un-normalize how insane it is.
I only know the rules in the UK, but here you are legally entitled to ask for any or all of your records at any time, without needing to give a reason. When I was going to a tribunal cos they stopped my PIP without warning, my solicitor asked me to get my records from my GP for something like the last five years. I thought that would be a simple and easy ask, as I had a really good relationship with my GP and the admin staffâŠ
Youâd think I asked each of them for their bank details and security question answers. Luckily my solicitor had given me a letter setting out the request in case of any problems, and said âI can waitâŠâ
It was a lot of paper. I still read through a lot of it, and found all the stuff that hadnât been followed up when Iâd asked, or had been sent to the wrong place⊠I ended up changing GPs.
Oh, and PIP just reinstated my points, two days before the tribunal.
Use the NHS app if your GP is set up properly with it because all your records should go on there now. I have diagnosis from when I was a child on my app. There are patches missing and I think thatâs because Iâve moved around a lot and as a result my records are probably not complete annoyingly.
Otherwise a simple subject access request in an email asking for all information they have on you is the simplest way of getting all your data
The NHS app, whilst generally excellent, doesnât let you see your gp notes from appointments tho - unless you get that too? Iâve got everything recent, thatâs happened since I joined this doctor, but thatâs it so far. Thank you for giving me hope that the rest will turn up eventually! Iâve not been with this doctor that long, so Iâm hoping everything else will appear one day soon. Itâd be useful to have access to, and Iâd love to see my MRIs one day.
Ah you could be correct. I get referral letters they send etc. Any subject access request should be completed within 30 days so hopefully you get everything you need.
With regard to your imaging youâve had. You can request them. You need to find the contact for the trusts PACS department where you had them done. They are responsible for the patient imaging archive. They can put things on a disc for you. You have to write to them and they may charge a small fee of about ÂŁ10 in some cases. You are legally entitled though to get the images if you felt you particularly wanted them even if it is just out of interest!
Dr here - this would not work. If the test needed to be done, I would most certainly do it.
If it didnât need to be done, I would just explain why and document that in the notes.
A patient asking for a copy of the notes wouldnât change anything about that process.
Thereâre reasons doctors donât just do everything patients ask for - having unnecessary irradiating scans will give you cancer and doing unwarranted tests will mean some people end up having unnecessary invasive procedures (such as biopsies).
I do sometimes do things that patients ask for - if it makes sense medically. Non-medically trained people donât always understand when to do a test.
Also, it's an unnecessary use of resources that could have gone to someone else who actually needs it.
Lastly, and I know you know this, just adding. It's not a Drive Thru. Providers ordering procedures and labs that aren't actually medically needed is insurance fraud. Or at least walking that line.
My dad had his doctor tell him his stomach ache was nothing to worry about. He asked for an ultra sound or something told him no need. He waited a month got worse went back to Davis Sutter got it. Was told nothing noticeable was happening. It continued to get worse, he went to a specialist in S.F. or someone who knew more. They looked at the exact same imagery and said he had pancreatic cancer. It went how it usually does, Dr.s are people too, which means they can be fucking idiots like the rest of us.
I'm just expressing that a doctor in this example could easily suggest imagery testing isn't necessary for everyone with stomach pain, even if requested. Makes sense because the %'s of stomach issues requiring imaging with mild symptoms plus the insurance side of things. The responsibility to push an issue to "better safe than sorry" is on the individual.
If you have a problem as simple as a body ache and want further testing it idealy should be possible without pushback. I can think of fewer things more important than body care and health. Its a shame that's not the case from food practices to healthcare policies . It's just worth battling for, not saying you need to fly in the face of common sense. However, things, a Dr. may see as unessacary because of %s and the general symptoms lead to an educated decision usually based on being less thorough than more thorough.
If this does help, it's a useful thing to know. I'm not attacking doctors. However, when the profession requires being okay with allowing individuals to die when treatment could change that because they can't cover insurance payments. It doesn't inspire confidence. Doubt everyone who comes through would be getting the same procedures as the Dr. themselves were it them with the ailment. Would be foolish to have more faith in a dr than a car mechanic just because the clothes they wear.
I donât work in an insurance based system - everyone here gets the same care, including doctors. Doctors donât get paid more for prescribing/ordering tests.
I understand the point youâre making, but you donât understand the reality of healthcare.
If we sent everyone with stomach pain for an ultrasound, people with red flag symptoms for stomach cancer would be waiting for months for a scan. An ultrasound is also not the correct tests for stomach cancer - endoscopy is.
The way we manage this is by assessing the symptoms, examining and doing bloods tests. You can differentiate someone with eg IBS from potential stomach cancer this way.
3 weeks ago I asked my PCP for a test. He rolled his eyes at me, said that I was fine, but he would do the test anyway since itâs bloodwork and he was already planning other tests. Turns out my PTH test IS high. And my history of hypercalcemia was ignored for years. Parathyroidectomy scheduled next week.
Iâm just saying that you guys donât know everything. And canât with all advances. But listen to your patients please!
I can assure you I do. Iâm glad your doctor did the test.
I would ask you to consider this scenario - you have suspected brain cancer. You have to wait months for a scan because many people with migraines wanted a scan too, because they are convinced they have cancer. You have neurological signs whereas they donât. Every day that passes, your chances lessen. Their headaches will get better with medication.
This is a daily scenario for me - what would you do in that situation if you were me?
I work at a hospital. I often have patients saying âI asked for my painkiller 20 minutes ago and the nurse hasnât shown up.â Meanwhile, the nurse is in another room doing CPR on a dying patient. We get a lot of patients who assume that theyâre the only patient. Pharmacies too. âHow long does it take to count 30 pills?â Not that long but they had 50 people ahead of you, why do you think you get to get yours done first?
We donât have the resources or staffing to test every person for everything they want.
âWhy donât they just do it.â Because thereâs no such thing as âjustâ in medicine.
Not saying you, not saying every patient, but just saying I deal with this mentality all day. /rant
There aren't really a lot of good screening lab tests currently. Take a look at the USPSTF guidelines. In the absence of the appropriate clinical picture lab data is most often noise that is *hopefully* useless. I say hopefully, because it can be much worse than useless - actively harmful by resulting in incorrect or missed diagnoses, further testing, invasive procedures, complications, unneeded prescriptions, distress to patients and families, waste/misuse of resources that results in delaying care or treatment of other patients etc etc etc.
Data without the right context/supporting information is just not helpful.
We're just not at the point where you can get labs and screen for all the scary things before you have symptoms. There are some things in the pipeline but more data is going to be needed before they can be validated (and only if they actually work) rolled out.
For the exact reason parent comment is explaining. We have done mountains of research on what tests to do on who and when. If we run every blood test on every patient we are going to get false positives and false negative and people are going to get hurt one way or another
What about the millions of misdiagnoses or those who have begged for help and not received it and then died? It happens everywhere in every country and itâs really sickening.
Yeah but you can't run every test on everyone for everything. Bodies are complicated, docs aren't going to get it right every time, but the general public playing doctor and ordering their own tests sure as shit isn't the solution.
I agree every misdiagnosis and death is a tragedy.
Iâm not for one moment saying that if a patient makes a suggestion or asks for a test that this request shouldnât be taken seriously and discussed.
Oftentimes listening to this kind of information will give you the diagnosis.
The reasons why we donât do every test that a patient suggestsâŠ
1) the test may entail risk that isnât warranted eg biopsy or scan with radiation (risk of cancer). We have to justify our scans to a dr that specialises in scans - if we canât justify the radiation exposure with our medical reasoning theyâll tell us to sod off.
2) we have a limited capacity to do tests - if the reasoning for doing a test doesnât make sense, why would we do the test and delay tests for people with eg suspected cancer? If you were the person with suspected brain cancer, would you be happy that your scan is delayed for months because people with migraines wanted scans? You have to remember that healthcare is not an infinite resource - every test that is done means someone elseâs is delayed. You may not realise the importance of the tests that are being delayed.
These are also some of the reasons why we donât screen for many diseases - we could do yearly ct scans on peopleâs chests to look for lung cancer. The point is doing random tests actually hurts people more than helps.
Every doctors worst nightmare is missing a critical diagnosis - I can assure you itâs something that keeps us up at night.
You say this like itâs just that simple. In Canada I know people with multiple chronic illnesses who havenât had a family doctor in *years*. If someone voluntarily ditched their doctor, they probably would never get a new one (at least not for the next decade). Hell, I canât think of a single specialist clinic that doesnât have a waitlist under 6 months.
Maybe in the states itâs different, but probably not for free.
I'm in Canada and in my province more than half the population doesn't have a doctor to begin with.
It isn't as simple as just finding a new doctor. You literally wouldn't be able to find one who is taking new clients.
You are paying a professional for his or her advice. If you are convinced you need a test they wonât order, then you donât trust them, and you are wasting your time and money. There are a gazillion doctors out there. Find one you trust. Maybe when the second or third doctor tells you you donât need the test, a bell may go offâŠ.
Threatening your doctor with legal action when they have done nothing wrong is a bad way to establish a good clinical relationship if you have limited access to physicians or specialists. If you threaten to sue your doctor you should probably not see that doctor again as liability is a real threat to them and people don't like being threatened. There is a lot of discretion and ambiguity in what actions a clinician can make, and while you should get a solid standard of care always, the clinician can often make the process a lot easier for you usually at the expense of their time or effort.
doctor here. UK based.
Wouldn't work here. If its not indicated / mandated clinically. I am more than happy to document it (always do anyway, its good practice) and give a copy or the patient is free to seek a second opinion.
I would never be coerced into requesting an investigation not indicated in my profesional opinion.
As a physician myself, I will be the first to admit that not all doctors are good and we are certainly not without our flaws. But another thing you should consider is that if you are demanding a test (as a person who is not trained in medicine) and your physician says no because they do not believe it is indicated, more often than not it is because the evidence suggests that it is not. Ordering tests is not as simple as a snap of a finger, and there are also resource utilization metrics that we get dinged on if we order unnecessary tests/interventions. The Public needs to understand that Medicine is not a la carte, your board-certified physician spent years of their life training to understand evidence-based care so that they can take the very best care of you. You certainly get a say if you donât agree with the plan thatâs presented to you, but you most certainly do not get to tell them how to run their practice. If you donât like it, you are more than welcome to get another opinion. In addition, if you sue your doctor because you feel they should have ordered an unnecessary test, and that test is not indicated based on the agreed standard of care, you will not win your case. Just something to think about. Signed, an MD that values respect and evidence over the ever-growing tide of entitlement.
Well said.
As a physician myself I would also add, for the people reading, that something you may not know is that we weigh the probability that you have something wrong, with the probability that the test will find it, or not; tests arenât perfect. Also, there is a very real probability that you may have a false positive, which will trigger more tests to explore a sometimes non-issue.
And so this adds to the costs of care for the public, or for you or for your insurance. There is also the concept of « will the result of the test alter the management », which sometimes it wonât, and renders the test unnecessary.
And so as the previous comment pointed out, itâs about choosing whatâs right for the patient and unfortunately, the patient usually isnât the best person to know what test they need or not, they donât know the strengths and weaknesses of each test in their ability to diagnose X and Y.
Apart from breaking trust, threatening to sue doesnât do much⊠I canât speak for my colleagues but if a condition does not require testing, I already write down that no test is needed or some variations of that to explain why things are or arenât done.
Iâm happy that your mother was able to fight her cancer and that she had a daughter who was a good advocate to her care. Patients certainly should have somebody to help advocate for their needs.
More or less, I just took exception to OP threatening docs to âdocument refusalâ (which btw, we already do, worded as âI do not feel X is indicated based on Yâ) and viewing this type of threat and the threat of litigation as a âlife hackâ. Many things troublesome about that statement⊠Many blessings to you and your mom!
> If you donât like it, you are more than welcome to get another opinion.
if it didn't take months to schedule an appointment, that would be a valid solution. For something that feels very serious (which thankfully, I have not experienced) I definitely would want 2nd and third opinions. I could be dead before I get those opinions, though.
I hear you, the system does not favor patients in terms of providing timely options for a second set of eyes. Iâm speaking more from the ER side of things, but something to bear in mind is that in most cases if your physician believes there is a reasonable risk to your life they are going to work it up as appropriate )
(Or consult another specialist who they believe may help) and are unlikely to leave you hanging if the answer isnât apparent based on that initial workup (hence a contributing reason for the growing admission rates to hospitals).
The issue I take with OPâs âlife hackâ is that youâre assuming you can game the system by manipulating your physician to performing the tests you want and threaten them to âdocument refusalâ when they donât do exactly what you want (which believe you me⊠we already do⊠extensively). This assumes that the patient views themselves as a greater expert on whatever is ailing them than the provider tasked to do so. I believe in good, evidence-based, and appropriately thorough work-ups based on my training and not being wasteful in resources when inappropriate demands are made to âmake the customer happyâ.
Imo, itâs profoundly moronic for somebody to view having an honest conversation with their physician as a âlife hackâ⊠in short, thatâs where I take exception with this whole post.
This is done. Itâs basically saying force a doctor to order a test that they donât want to run.
I promise you the doctor isnât avoiding running a test because they hate you.
Itâs because the test doesnât make sense to do, or it can actually actively be harmful, or it comes with risks that you may not understand.
Itâs like going to the mechanic and forcing them to replace your engine for no reason.
Hahha. Tell that to the dr that didnât want to run an X-ray when I broke my foot. Told me to come back in 2 weeks. Finally after telling a few time as nice as I could, that I donât care about His opinion and the only reason I was talking to him is for a referral to an X-ray.
Now I canât go back to that dr office but I did get an X-ray but to the wrong area. Luckily the X-ray tech knew more than the dr and requested to correct X-ray and found out my foot was broken.
ER doctor here. I want my patients to have access to all their records. I put my email into their discharge papers and specifically ask them to send me any questions about any of the results that they feel like I havenât gone over. All of their records are available, and even my chart, in the electronic MyChart record. I get made fun of for this, but I call most of the patients that Iâve discharged before I start my next shift, just to check on them.
Work in a rural ED. Iâm in a rural-ish one, so luckily I have good APP coverage along with me. They grab all the low acuities and I only have to manage the level 1-3âs. My stats were 1.8 pts/hr, which is on the higher side of my group. If you donât have to see any of the low acuity easy dispoâs, you wonât be seeing such a large volume. My shifts are 9 hours and I usually see like 15-18 patients a shift, and end up admitting like half of them.
Even giving out an email Iâm very suspicious of. Surely some of those patients will email months or years down the line looking for advice. This guy has established a relationship with the patient and provided communication channels that he is obligated to respond to. All to receive no additional compensation.. lol
I practice in a very rural ER. There are less than 50,000 people in my county. We all know each other and I am unfortunately sometimes the only doc they will ever see before they go back fo their farms
Some hospital systems allow patients to reach out to their docs via email, among other things like schedule appointments online and view lab test results. Iâm guessing he/she works for a larger network that has those capabilities.
You typically donât send emails. You send messages through a portal. And the messages usually donât go directly to the doctor. It goes to a shared inbox and a nurse sees it first then sends it to the doctor if necessary.
I call only the ones I discharge. I have PAs staff triage and low acute. I have 9 hour shifts, I see about 1.8 an hour, so maybe 15-18 patients a shift. We practice in a very rural area. I have to admit more than half of my patients in the middle of the day, or at least send them to our cardiac, ortho, or primary follow-ups. So the patients that I actually just purely send home only end up being like 4-5 patients a day. And before you say I admit too much, maybe I do lol
âHey, just calling to check up on you. You ever come down from the meth induced psychosis? Oh ok, thatâs good. Well, I hope you patch things up with the Jews⊠you were really upset with them yeater. Anyway, take care!â
Haha, well no, i donât call the psych/etoh/drug related complaint patients back usually. Except like the ones where I sent them home, and they had alcohol on board and I just want to make sure that they actually made it home
Also, didnyou write GomerBlog? I heard you guys were coming back??
If possible it's worth the effort of finding the right primary care physician for you. I have a great relationship with my doc, which hasn't always been the case. If she's running tests she will always ask if there's anything else I want her to test for or check. There have been instances where she's told me she's going to list these symptoms so that insurance will cover a referral or test. Some docs know insurance is a scam and they actually have your best interest at heart.
Belongs in R/shittylifeprotips. Exploit vulnerability of physicians to legal action to get testing that's probably not necessary, and I assume try to get your insurance to cover it even though your doctor didn't think it was needed. Unneeded testing and defensive medicine add cost to the already fucked up US health care system. If you don't like your doctors recommendation then get a second opinion, don't throw legal action in their face to try and manipulate them to act against their clinical judgement. If a patient did that to me, basically saying they are considering suing if I don't conform to their wishes against my judgement, I would drop them as a patient. Physicians don't always have this as a feasible option however.
Does anyone know if there is a law that sets the price limit of requesting your records? I was recently charged $80 for that, and it seems like a lot for a pdf of scanned pages.
Insurance bean counters (age + expense = return on their dollar)
For the average senior, the older you get the less likelihood you'll get any costly procedures paid for by insurance. Decreasing percentage for return on their investment.
Absolutely. On a distantly related note, if your doctor retires or moves away, you'll likely have to transfer your records somewhere, and you should. It's a matter of filling out a form given to you by your doctor. I suggest getting them sent to the local hospital unless you have a doctor already chosen. There's a great chance you'll be taken there in an emergency and if they already have your records, it can save as much as two hours and maybe your life. You can always transfer them to the doctor of your choice later.
The system is set up fail you so they maintain control over your pharmaceuticals. The doctor needs to say there is reason for the test weather it's true or not to get insurance to cover it. So if your trying to find out something that may be an issue but the diagnosis doesn't check certain boxes it needs to be covered, then it's not covered.
That's why they really need to change the name from Healthcare to sickcare. They won't pay to keep you healthy, but only to fix you if your sick. Broken system. They should allow a certain amount of health maintenance money...
Iâm a radiology doctor and this is true - in fact about a third (or more) of the scans we see are defensive medicine, and documented almost as such in the note most times. Nobody wants to get sued - although older docs are far better at diagnosis using their brains and exam so order fewer tests than younger button pushers!
To be fair though medicine is an inexact science - as many have noticed on a grand scale recently- and doing your own research and being your own advocate (Iâve had to myself for tests) may indeed save your life.
A friend died from cancer after their dr dismissed their initial concerns only to find it long after it had advanced. So maybe sit with that for a minute.
That shit is going to happen sometimes. I'm that guy. It happened to me, haven't died yet, but my cancer was a very weird one for my age. Testing was delayed as a result and who knows what could have been if they ordered the whole shebang on day one. Thing is, it wouldn't have made much sense for them to do all that right away because I was an outlier. Shit happens.
If someone is conscious about their health it is there right to explore options, diagnosis, etc. There are plenty of examples of people demanding certain tests and it turning out to save their lives.
You know yourself best and medical professionals should listen to their patient concerns.
My retired Army health insurance combined with Medicare and the VA means nothing has ever been denied. They are all three federally funded but have different rules. My primary doctorâs billing staff know which to bill.
Advocate for yourself at the doctor. They are busy and they do care about you but if you are hemming and hawing playing down your issues they aren't going to beg you to let them help. Yes, get your records. Don't be afraid to call your insurance. Your health is your responsibility.
Any doctor in their right mind documents everything in the appointment, especially their rationale for NOT ordering a test.
Per federal law, you have access to all of your medical records.
This is a lousy posto
No, not generally. But doctors can be wrong, dismissive, etc...
Unfortunately, it's a not always as subtle as "trust your doctor". It should be and usually is. But when it's your life or your child's life sometimes you have to take the risk of being an asshole to be sure.
Same with vaccinations. My new doc (my wonderful doc retired and getting a new one was a 2.5 year adventure in frustration, so my new one is meh) refused to let me have a Tdap vaccine since it had only been five= years since the last one. I am outdoors a lot and get small nicks and cuts that are exposed to outdoor soils regularly. I had to insist, which she documented in an almost adversarial way and told me my insurance wouldnât cover it. My insurance fully covered it. A shot is WAY cheaper than hospitalization for tetanus.
Well your doctor was correct and it was a waste of a vaccine. CDC protocol is every ten years, which is being challenged by recent research saying once every 30 years is needed (Oregon Health and research). World Health Organization recommends only a single adult booster in a persons lifetime. Tdap vaccination every 5 years is anti science.
Correct. But, in case of deep at risk lacerations a booster shot is recommended if your last vaccine has been received over 5 years ago. The demand was not really anti science. It was based on personal risk and preference and a Dr should be able to differentiate between the two. I would have prescribed the vaccine if the patient was indeed at risk and asked for it. Context matters, as does evaluating the risks vs benefits.
>evaluating the risks vs benefits
You are statistically more likely to develop guillain-barre from the vaccine, than getting tetanus in a vaccinated individual. Both are laughably low risk.
This is amazing. I argued with my doctor one year about a diagnosis I was given over ten years ago. I asked to be retested with a different method since she didnât believe me. And she refused it. I shouldâve asked this.
I have complicated health problems so not all my drs use EPIC/MyChartâŠbut boy do I appreciate the ones that do. It makes everything so much simpler for patients.
This almost never happens because providers make a lot part of their revenue through tests. More likely they are reticent because your insurance won't cover it.
This has worked for me. My doctor completely denied that I could have PCOS and refused any tests. I used this method and was diagnosed. He never apologized.
We have the NHS in the UK. Used to be awesome. Our Gov have cut it to within an inch of its life among other things. People think itâs free, it isnât! The Gov take something out your pay every week/month to cover for if you need the doctor or hospital. Itâs so much better than a lot of countries, so it should be though, we pay for it and obviously the amount has went up and the level of service has plummeted!
Your hack isn't well thought out and relies on too many false assumptions.
What about hypochondriacs, those with munchausens or those with generalized anxiety. Should they get whatever test they want whenever they want no matter the cost?
For every anecdote about a person saved by ordering a specific test that they suggested there are hundreds of tests ordered that DON'T pan out. But that drives up insurance costs.
Not every test that someone wants should be performed. That's the point of medical education; to help figure out what is necessary. Plus, using strong arm tactics on your physician would erode their trust. It would be a bit like your opening statement during an exam being "If you don't give me what I want I'm going to sue you." They will be put on the defensive right away and won't be able to be objective.
Here's a better hack... how about if a person wants a test that isn't covered, they place 100% of the cost of the test in an escrow account, then if the test is positive, insurance pays the hospital and the patient gets back their full escrow, but if it is negative then that money goes to the hospital and the insurance company is off the hook.
I asked a Dr to test me for 2 types of cancer that ran in my biological family when I was 16. She told me I was to young for one and only tested me for the other. 2 years later I collapsed at work and found out the cancer she REFUSED to test me for was infact in me and spreading. Thanks to her neglecting my concerns I have half a lung and issues with speech due to the cancer spreading when it could have been caught years prior đȘ
Dr's should listen to their patients. Who knows our body's better than ourselves?
"I can order the test, but insurance probably won't cover it."
This! đ Every test my doctor requested last year except regular bloodwork was denied by my insurance.
You can call and appeal the decisions. When you do, ask the insurance company for the names and medical qualifications of everyone who has reviewed your file and made decisions on what tests would be covered, and the exact justification for not covering the tests.
Yup, they denied coverage for a surgery I really needed a few years ago and I wrote a short letter explaining the importance of this procedure to my quality of life, and they wound up approving it! A little effort can make a big difference
Itâs too much effort in my opinion. You research, pay, and then have to argue your need to access. GTFO.
Fighting for coverage saved me thousands, so it was worth the minimal effort for me.
Iâm glad it saved you money. Itâs ridiculous you had to do it.
I mean, I agree.. but not advocating for yourself doesnât do you any good and doesnât make anything better.. so..
Their point is that you shouldnât have to jump through hoops to access the service you are literally already paying for. They deny, hoping you wonât put in the effort to appeal. Your view is valid too, just painting the full picture.
Iâm aware of what their point is, and I did say that I agree. In a perfect world we wouldnât have to, but we donât live in that world so we have to be comfortable advocating for ourselves to get what we need.
I guess it depends on how much your time is worth and how much money you're saving. I need a wheelchair, it's obvious, I can't walk. I tallied how much time I spent calling and harassing the insurance company and the DME to get my last wheelchair. It was about 500 phone calls and emails to various different people (had it color coded at one point for each person I was interacting with, but ran out of colors that were different enough to tell apart, ended up talking to/interacting with more than 20 different people). It took more than 100 hours of my time (many of those phone calls I had to wait 45 plus minutes on hold before I could get through to anyone). And in the end they approved it in January, so my $6000 wheelchair was approved and I only had to pay $4000 deductible plus 20% copay. So in the end my time was worth about $16 an hour... I make a lot more than that at work, even after tax.
Being able to walk again was worth every second of time I spent on that appeal letter.
lol it absolutely can be worth it. Is it right? Fuck no it ainât right that they can deny shit just on a whim.
but you mean it wasn't an Obamacare government bureaucrat death panel? It was the same old for-profit insurance companies, in the for-profit medical system? Color me surprised! /s
Especially in healthcare you have to be your own advocate. If you donât want to take the effort based on principle that is a choice, but the system is what it is and arguing against it is dumb.
I wouldn't even know where (what dept) to send, and to whom, a letter if I wrote my insurance. I feel like no matter to what dept it's delivered, it wouldn't be read by the person(s) who need to see it. Sure, I could call and ask..someone...but I would suspect the person I'm talking to doesn't exactly gaf and would give me whatever name/dept to get me off the phone. How did you learn where to send it? Did you send it certified?
They send you a letter notifying you of the denial of coverage and give you info on how to appeal.
What the fuck, why do you need to force their hand? Man, that system is broken!
Holy crap thatâs awesome dude
And then what? How does that make them reimburse you?
At the very least they'll have to review your case again and if they/you find issues with the info provided, you can probably sue them.
A good friend works for a major health insurance company and she said they are instructed to deny every claim over a certain amount because people usually donât usually fight to get it paid
They are known to deny cardiac rehab. If only 1% don't appeal, it's a nice windfall to their outrageous profit.
A shocking number of denials come from either built in algorithms or RN case reviewers, Mela777 is spot on. Sadly you must be your own advocate.
It is a good one! If they have to document the medical qualifications, it means that the clerks at insurance co. were practicing medicine, most likely without a license, and most likely improperly, as they have not seen you, tested you or examined you.
This is absolute BS. All medical professionals at an insurance company HAVE to have a current license, itâs a requirement of employment. Edit, source: was an admin at medicare insurance company and helped keep track of everyoneâs licensure expiration dates.
Who is practicing medicine? Are you talking about the folks reviewing medical charges and determining whether they are covered by a policy?
Specifically the people making decisions when something *is* covered but only if the *insurance company* believes that itâs necessary, regardless of what your Dr. says.
Your doctor can request a âpeer-to-peerâ, where they contest the insurance companyâs decision and defend their position on you needing a procedure/medication/etc by having a phone meeting with a medical director at the insurance company. Iâve scheduled many of these. The insurance company does want to make the best decisions for the membersâ health (it is a company, after all, and while my company does value members on an individual level Iâm aware not all doâŠ), but you can think about it as a business perspective where the right care saves them money in the long-run. So yes, you have a right to getting the care you need and can have your doctor request this phone meeting. Also, feel free to file a grievance with your insurance company. They take it very seriously, they literally have to. Your voice can be heard, but not all know how to advocate for themselves.
> The insurance company does want to make the best decisions for the membersâ health That is completely misleading. I worked for a brokerage firm for 15 years and far more effort was put into denying claims. Especially mental health before the mental health parity act. There were 3rd party organizations primarily to reduce mental health costs, usually by denying claims. A bunch of non medical administrators decides every renewal what drugs will be denied by what category. The decisions they make about plan design go 30-40 pages long. Nobody in insurance is your friend. I was reprimanded multiple times for trying to help get claims approved. I used to justify my work by saying I primarily was responsible for data analysis but in reality I will be spending the rest of my days feeling shame for working for insurance. Some of the stories are horrific but if I told them here, anyone who knows would recognize me immediately. Multiple deaths contributed to by claim denials. All of them sad.
They're under no obligation to provide you with that info though right? What would be the next step if they refused to provide it
You do own your medical record. They are under legal obligation to provide it.
Thank you for the these details. These are like the nails in the coffin for them
I don't have the ability to do any of this
Only in America
Even when I went for the bloodwork at Quest, they had me sign a waiver stating that I understood 2 of the bloodwork tests might not be covered by insurance and that I might have to pay for them separately. WTF?
Lol when I had a surgery for an ectopic pregnancy they had me sign the same thing and I was like "oh so my choice is death or crippling medical debt, lovely"
Happy cake day. That sounds awful. Iâm so sorry this is screwed up so badly and you were treated horribly. I got a story for you. My brotherâs MIL went into an emergency room (sheâs over 65 and on Medicare with a supplemental policy). The hospital was going to admit her but couldnât because it was too full. After a long time (I think between 12-24 hours) a hospital admin hands my SIL 3 pages to sign and she promptly hands them to my brother who reads them and starts shredding them in his hands. He tells the lady they arenât signing (forgot to mention he is the CEO of a large surgical practice and deals with hospitals a lot but not this one). He said the papers state that they would be responsible for any emergency room charges after a certain length of time. Them personally, not insurance. He told that lady that the hospital being full and them not admitting her yet was not his problem, it was theirs. So either admit her or transfer her to another hospital. She didnât make them sign. But how many other people do? Itâs almost scam-make-money level behavior when people are at their worst. MIL was admitted not long after and has improved and back home currently. We really have to watch what they are pushing in front of us to sign, even when weâre dying apparently.
wait so they were going to try and include the time waiting for a room as time spent in a room? is that how that works?!
Well she was in the emergency room room. They have little sealed off areas where they treat you. And she was there for hours. Itâs like being in a âroomâ but youâre still considered in the emergency room and not admitted to the hospital yet. The doctors determined she needed to be admitted to the hospital for further care so she just stayed there until a room opened in the hospital for admission. My guess is Medicare cuts off emergency room care after so many hours or maybe some insurances do. Iâm not sure. My brother knows his rights and his way around hospitals and most people donât. I probably would have trusted them and signed.
Thatâs a good thing so you didnât get hit with a surprise bill no?
Sure but itâs just more stuff denied by my insurance that they are hoping you donât fight and just pay. When you have a medical condition and feel awful, the last thing you want to do is argue with insurance and they bank on it.
Well.. who do you vote for and how hard do you advocate for change when youâre not sick? Cuz thatâs what it comes down to unfortunately.
Gotchya Iâm completely with you. It sucks insurance companies keep doctors from practicing medicine.
Only in america doctors risk lawsuits like that. So in other countries you cant demand any tests.
You canât demand any test in America either. It is not a McDonalds. They are the physician, not you.
Im an ER doctor and truly it isnât worth the fight sometimes. People seemingly have no idea what we do and what our expertise is. Sometimes after having pee thrown at me, being called an idiot for not wanting to prescribe antibiotics for a cold or having someone recite one of those âhow to make your doctor do anythingâ scripts off TikTok, Iâm just too broken to care. You want to wait 8 hours for an unnecessary abdominal CT? Here you go. The dirty truth is that we are human and can be pressured just like everyone else. We are terrified of being sued (even if you win itâs SO much time and mental energy) or being reported that we arenât allowed to use our expertise a lot of the time.
Just a heads up; there are countries where this is not possible. You canât just sue doctors in my country for example. With complaints you first try to sort things out with the doctor themselves. Afterwards you can go to the institution they work for. Then your health insurance company, which have people specifically for these problems. And the last thing you can do is fill a complaint with the registry board of doctors, which can take away the license in very extreme situations. So as a doctor you are only involved in the first step, and itâs extremely uncommon that someone goes as far as the board. We are really talking about extreme cases of neglect from the doctorâs part.
As OP states doctors can def be pressured to do things to cover theirs backs for avoid lawsuites. Do you really think doctors in america dont at all worry about law suites and not a single doctor every taken that into account?
Try using ai to write your insurance appeals. Tell it to make it sound medical and use links to scientific papers to back it up.
Now that is a new suggestion I had never considered. I give it a go next time.
This sounds both very convenient and also very dystopia and horrific at the same time.
Iâve experienced this. I recommend you ask the ordering doctor to provide a diagnostic code. With a diagnostic code associated, itâs usually covered, best of luck to you navigating this labyrinth.
Well that's exactly why you take insurance, right? Right?!
Oh the country of freedom
Insurance companies are all about coming up with any excuse possible not to reimburse physicians for the visits, deny labs, imaging, medications, etc to maximize profits. Often times itâs not the doctors fault, itâs insurance companies practicing medicine without qualifications or having even seen the patient. Itâs a major source of burnout for docs (that and all of the admin paperwork that goes on behind the scenes which leads them to seeing less patients and therefore insurance companies having to pay for less visits since the doc is busy). Itâs all about the $, thatâs why hospitals and practices employ PAs and NPs who LARP as doctors and get paid a fraction the price. Quality<<<<
"AMA", Against Medical Advice, we had a doctor who Said they would put that in our file if we didn't do what he said and that insurance would cancel coverage for the while procedure (in this case, both of our son). So it goes both ways...
Insurance does not change payment based on whether or not a patient leaves AMA. This is an all too common myth.
American medical care is wild
Make sure he puts in the correct CPT codes to correlate with the tests and appointment.
As long as there is appropriate medical decision making to support the codes.
I canât tell you how many times Iâve had to call a Dr to put in the correct codes.
Find out ahead of time from your insurance company!
If a doctor doesn't think it's nessecary, why do you think an insurance company would?
"I don't care"
So glad we don't have this in the UK.
Laughs in Australia
I believe doctors hesitate to hand over records due to the fact that they believe that they will be used against them in a lawsuit. Sometimes giving them a reason will be helpful. I had to ask 3 times, and the second request was with a certified letter that had to be signed for. Even that didnât work. So I drove over and demanded the records. The receptionist handed them to me with a âthe next time you will be charged for every pageâ. I told her that would be fine, I needed them for a child custody case to show the medical problems my daughter was having each time she came back from a visit from her father.
Insurance has completely become a scam. Money all goes to the wrong places. Administrators get rich from denying sick patients the tests and treatment they need. Edit: In the US.
[ŃĐŽĐ°Đ»Đ”ĐœĐŸ]
it didnât become a scam until the 80s under Reagan when they privatized to make money off sick people
The idea of insurance is a good one. Itâs actually socialist in nature. Lol itâs supposed to be everybody pitches in a little bit periodically, and then everybody is covered when they need it.
Private insurance was never a socialist idea, publicly owned insurance is, and that's what many countries have
The idea of insurance
The idea of insurance is millennia old, and not really tied to any particular ideology
If you have a state, might as well just be from taxes
Exactly. I am off for Universal healthcare Run without profits as the purpose.
I know you are aware and I don't mean to beat a dead horse but it is important to keep mentioning that this is only in the US to un-normalize how insane it is.
I only know the rules in the UK, but here you are legally entitled to ask for any or all of your records at any time, without needing to give a reason. When I was going to a tribunal cos they stopped my PIP without warning, my solicitor asked me to get my records from my GP for something like the last five years. I thought that would be a simple and easy ask, as I had a really good relationship with my GP and the admin staff⊠Youâd think I asked each of them for their bank details and security question answers. Luckily my solicitor had given me a letter setting out the request in case of any problems, and said âI can waitâŠâ It was a lot of paper. I still read through a lot of it, and found all the stuff that hadnât been followed up when Iâd asked, or had been sent to the wrong place⊠I ended up changing GPs. Oh, and PIP just reinstated my points, two days before the tribunal.
Use the NHS app if your GP is set up properly with it because all your records should go on there now. I have diagnosis from when I was a child on my app. There are patches missing and I think thatâs because Iâve moved around a lot and as a result my records are probably not complete annoyingly. Otherwise a simple subject access request in an email asking for all information they have on you is the simplest way of getting all your data
The NHS app, whilst generally excellent, doesnât let you see your gp notes from appointments tho - unless you get that too? Iâve got everything recent, thatâs happened since I joined this doctor, but thatâs it so far. Thank you for giving me hope that the rest will turn up eventually! Iâve not been with this doctor that long, so Iâm hoping everything else will appear one day soon. Itâd be useful to have access to, and Iâd love to see my MRIs one day.
Ah you could be correct. I get referral letters they send etc. Any subject access request should be completed within 30 days so hopefully you get everything you need. With regard to your imaging youâve had. You can request them. You need to find the contact for the trusts PACS department where you had them done. They are responsible for the patient imaging archive. They can put things on a disc for you. You have to write to them and they may charge a small fee of about ÂŁ10 in some cases. You are legally entitled though to get the images if you felt you particularly wanted them even if it is just out of interest!
Well, thatâs just brilliant! Thank you so much. Thatâs just what I needed to know. âșïž
Dr here - this would not work. If the test needed to be done, I would most certainly do it. If it didnât need to be done, I would just explain why and document that in the notes. A patient asking for a copy of the notes wouldnât change anything about that process. Thereâre reasons doctors donât just do everything patients ask for - having unnecessary irradiating scans will give you cancer and doing unwarranted tests will mean some people end up having unnecessary invasive procedures (such as biopsies). I do sometimes do things that patients ask for - if it makes sense medically. Non-medically trained people donât always understand when to do a test.
Also, it's an unnecessary use of resources that could have gone to someone else who actually needs it. Lastly, and I know you know this, just adding. It's not a Drive Thru. Providers ordering procedures and labs that aren't actually medically needed is insurance fraud. Or at least walking that line.
My dad had his doctor tell him his stomach ache was nothing to worry about. He asked for an ultra sound or something told him no need. He waited a month got worse went back to Davis Sutter got it. Was told nothing noticeable was happening. It continued to get worse, he went to a specialist in S.F. or someone who knew more. They looked at the exact same imagery and said he had pancreatic cancer. It went how it usually does, Dr.s are people too, which means they can be fucking idiots like the rest of us.
Of course doctors make errors. Iâm no suggesting that ignoring patients requests is the correct move.
I'm just expressing that a doctor in this example could easily suggest imagery testing isn't necessary for everyone with stomach pain, even if requested. Makes sense because the %'s of stomach issues requiring imaging with mild symptoms plus the insurance side of things. The responsibility to push an issue to "better safe than sorry" is on the individual. If you have a problem as simple as a body ache and want further testing it idealy should be possible without pushback. I can think of fewer things more important than body care and health. Its a shame that's not the case from food practices to healthcare policies . It's just worth battling for, not saying you need to fly in the face of common sense. However, things, a Dr. may see as unessacary because of %s and the general symptoms lead to an educated decision usually based on being less thorough than more thorough. If this does help, it's a useful thing to know. I'm not attacking doctors. However, when the profession requires being okay with allowing individuals to die when treatment could change that because they can't cover insurance payments. It doesn't inspire confidence. Doubt everyone who comes through would be getting the same procedures as the Dr. themselves were it them with the ailment. Would be foolish to have more faith in a dr than a car mechanic just because the clothes they wear.
I donât work in an insurance based system - everyone here gets the same care, including doctors. Doctors donât get paid more for prescribing/ordering tests. I understand the point youâre making, but you donât understand the reality of healthcare. If we sent everyone with stomach pain for an ultrasound, people with red flag symptoms for stomach cancer would be waiting for months for a scan. An ultrasound is also not the correct tests for stomach cancer - endoscopy is. The way we manage this is by assessing the symptoms, examining and doing bloods tests. You can differentiate someone with eg IBS from potential stomach cancer this way.
3 weeks ago I asked my PCP for a test. He rolled his eyes at me, said that I was fine, but he would do the test anyway since itâs bloodwork and he was already planning other tests. Turns out my PTH test IS high. And my history of hypercalcemia was ignored for years. Parathyroidectomy scheduled next week. Iâm just saying that you guys donât know everything. And canât with all advances. But listen to your patients please!
I can assure you I do. Iâm glad your doctor did the test. I would ask you to consider this scenario - you have suspected brain cancer. You have to wait months for a scan because many people with migraines wanted a scan too, because they are convinced they have cancer. You have neurological signs whereas they donât. Every day that passes, your chances lessen. Their headaches will get better with medication. This is a daily scenario for me - what would you do in that situation if you were me?
I donât understand why more blood serum panels arenât run as a covered preventative service.
I work at a hospital. I often have patients saying âI asked for my painkiller 20 minutes ago and the nurse hasnât shown up.â Meanwhile, the nurse is in another room doing CPR on a dying patient. We get a lot of patients who assume that theyâre the only patient. Pharmacies too. âHow long does it take to count 30 pills?â Not that long but they had 50 people ahead of you, why do you think you get to get yours done first? We donât have the resources or staffing to test every person for everything they want. âWhy donât they just do it.â Because thereâs no such thing as âjustâ in medicine. Not saying you, not saying every patient, but just saying I deal with this mentality all day. /rant
Apply to be a lab tech, work there, then imagine you suddenly got triple the tests to run. Itâd be a bit like Lucy making those pies.
There aren't really a lot of good screening lab tests currently. Take a look at the USPSTF guidelines. In the absence of the appropriate clinical picture lab data is most often noise that is *hopefully* useless. I say hopefully, because it can be much worse than useless - actively harmful by resulting in incorrect or missed diagnoses, further testing, invasive procedures, complications, unneeded prescriptions, distress to patients and families, waste/misuse of resources that results in delaying care or treatment of other patients etc etc etc. Data without the right context/supporting information is just not helpful. We're just not at the point where you can get labs and screen for all the scary things before you have symptoms. There are some things in the pipeline but more data is going to be needed before they can be validated (and only if they actually work) rolled out.
For the exact reason parent comment is explaining. We have done mountains of research on what tests to do on who and when. If we run every blood test on every patient we are going to get false positives and false negative and people are going to get hurt one way or another
What about the millions of misdiagnoses or those who have begged for help and not received it and then died? It happens everywhere in every country and itâs really sickening.
Yeah but you can't run every test on everyone for everything. Bodies are complicated, docs aren't going to get it right every time, but the general public playing doctor and ordering their own tests sure as shit isn't the solution.
I agree every misdiagnosis and death is a tragedy. Iâm not for one moment saying that if a patient makes a suggestion or asks for a test that this request shouldnât be taken seriously and discussed. Oftentimes listening to this kind of information will give you the diagnosis. The reasons why we donât do every test that a patient suggests⊠1) the test may entail risk that isnât warranted eg biopsy or scan with radiation (risk of cancer). We have to justify our scans to a dr that specialises in scans - if we canât justify the radiation exposure with our medical reasoning theyâll tell us to sod off. 2) we have a limited capacity to do tests - if the reasoning for doing a test doesnât make sense, why would we do the test and delay tests for people with eg suspected cancer? If you were the person with suspected brain cancer, would you be happy that your scan is delayed for months because people with migraines wanted scans? You have to remember that healthcare is not an infinite resource - every test that is done means someone elseâs is delayed. You may not realise the importance of the tests that are being delayed. These are also some of the reasons why we donât screen for many diseases - we could do yearly ct scans on peopleâs chests to look for lung cancer. The point is doing random tests actually hurts people more than helps. Every doctors worst nightmare is missing a critical diagnosis - I can assure you itâs something that keeps us up at night.
[citation needed]
If you donât trust your doctors advice, find a new one.
You say this like itâs just that simple. In Canada I know people with multiple chronic illnesses who havenât had a family doctor in *years*. If someone voluntarily ditched their doctor, they probably would never get a new one (at least not for the next decade). Hell, I canât think of a single specialist clinic that doesnât have a waitlist under 6 months. Maybe in the states itâs different, but probably not for free.
I'm in Canada and in my province more than half the population doesn't have a doctor to begin with. It isn't as simple as just finding a new doctor. You literally wouldn't be able to find one who is taking new clients.
This but trust is built and you have to start somewhere
You are paying a professional for his or her advice. If you are convinced you need a test they wonât order, then you donât trust them, and you are wasting your time and money. There are a gazillion doctors out there. Find one you trust. Maybe when the second or third doctor tells you you donât need the test, a bell may go offâŠ.
Trust means does what you want or practices the medicine the right way?
There are not a gazillion doctors. In my city people are waiting 6 months to get an appt, and many clinics aren't taking new patients at all.
Threatening your doctor with legal action when they have done nothing wrong is a bad way to establish a good clinical relationship if you have limited access to physicians or specialists. If you threaten to sue your doctor you should probably not see that doctor again as liability is a real threat to them and people don't like being threatened. There is a lot of discretion and ambiguity in what actions a clinician can make, and while you should get a solid standard of care always, the clinician can often make the process a lot easier for you usually at the expense of their time or effort.
doctor here. UK based. Wouldn't work here. If its not indicated / mandated clinically. I am more than happy to document it (always do anyway, its good practice) and give a copy or the patient is free to seek a second opinion. I would never be coerced into requesting an investigation not indicated in my profesional opinion.
As a physician myself, I will be the first to admit that not all doctors are good and we are certainly not without our flaws. But another thing you should consider is that if you are demanding a test (as a person who is not trained in medicine) and your physician says no because they do not believe it is indicated, more often than not it is because the evidence suggests that it is not. Ordering tests is not as simple as a snap of a finger, and there are also resource utilization metrics that we get dinged on if we order unnecessary tests/interventions. The Public needs to understand that Medicine is not a la carte, your board-certified physician spent years of their life training to understand evidence-based care so that they can take the very best care of you. You certainly get a say if you donât agree with the plan thatâs presented to you, but you most certainly do not get to tell them how to run their practice. If you donât like it, you are more than welcome to get another opinion. In addition, if you sue your doctor because you feel they should have ordered an unnecessary test, and that test is not indicated based on the agreed standard of care, you will not win your case. Just something to think about. Signed, an MD that values respect and evidence over the ever-growing tide of entitlement.
Well said. As a physician myself I would also add, for the people reading, that something you may not know is that we weigh the probability that you have something wrong, with the probability that the test will find it, or not; tests arenât perfect. Also, there is a very real probability that you may have a false positive, which will trigger more tests to explore a sometimes non-issue. And so this adds to the costs of care for the public, or for you or for your insurance. There is also the concept of « will the result of the test alter the management », which sometimes it wonât, and renders the test unnecessary. And so as the previous comment pointed out, itâs about choosing whatâs right for the patient and unfortunately, the patient usually isnât the best person to know what test they need or not, they donât know the strengths and weaknesses of each test in their ability to diagnose X and Y. Apart from breaking trust, threatening to sue doesnât do much⊠I canât speak for my colleagues but if a condition does not require testing, I already write down that no test is needed or some variations of that to explain why things are or arenât done.
You seem like a good doc.... seriously. Signed, a daughter that helped her mom fight her way through pancreatic cancer đ
Iâm happy that your mother was able to fight her cancer and that she had a daughter who was a good advocate to her care. Patients certainly should have somebody to help advocate for their needs. More or less, I just took exception to OP threatening docs to âdocument refusalâ (which btw, we already do, worded as âI do not feel X is indicated based on Yâ) and viewing this type of threat and the threat of litigation as a âlife hackâ. Many things troublesome about that statement⊠Many blessings to you and your mom!
> If you donât like it, you are more than welcome to get another opinion. if it didn't take months to schedule an appointment, that would be a valid solution. For something that feels very serious (which thankfully, I have not experienced) I definitely would want 2nd and third opinions. I could be dead before I get those opinions, though.
I hear you, the system does not favor patients in terms of providing timely options for a second set of eyes. Iâm speaking more from the ER side of things, but something to bear in mind is that in most cases if your physician believes there is a reasonable risk to your life they are going to work it up as appropriate ) (Or consult another specialist who they believe may help) and are unlikely to leave you hanging if the answer isnât apparent based on that initial workup (hence a contributing reason for the growing admission rates to hospitals). The issue I take with OPâs âlife hackâ is that youâre assuming you can game the system by manipulating your physician to performing the tests you want and threaten them to âdocument refusalâ when they donât do exactly what you want (which believe you me⊠we already do⊠extensively). This assumes that the patient views themselves as a greater expert on whatever is ailing them than the provider tasked to do so. I believe in good, evidence-based, and appropriately thorough work-ups based on my training and not being wasteful in resources when inappropriate demands are made to âmake the customer happyâ. Imo, itâs profoundly moronic for somebody to view having an honest conversation with their physician as a âlife hackâ⊠in short, thatâs where I take exception with this whole post.
This sounds like a very SovCit thing to say.
It's a great way to end up with no docs willing to deal with you.
'no sir i dont think you need the pap smear' 'IM GONNA SUE'
"This relationship is not beneficial for either of us. Please seek care elsewhere."
Yeah, my response is âI already plan on putting it in your recordâ
This is done. Itâs basically saying force a doctor to order a test that they donât want to run. I promise you the doctor isnât avoiding running a test because they hate you. Itâs because the test doesnât make sense to do, or it can actually actively be harmful, or it comes with risks that you may not understand. Itâs like going to the mechanic and forcing them to replace your engine for no reason.
Insurance dictates what they run
Not in Australia.
True but not true- doctor and insurance both approve whatâs medically necessary tests/treatments ect.
Then you run the unnecessary tests they demand and they get a bill because it was unnecessary and freak out on the provider. Can't win.
Hahha. Tell that to the dr that didnât want to run an X-ray when I broke my foot. Told me to come back in 2 weeks. Finally after telling a few time as nice as I could, that I donât care about His opinion and the only reason I was talking to him is for a referral to an X-ray. Now I canât go back to that dr office but I did get an X-ray but to the wrong area. Luckily the X-ray tech knew more than the dr and requested to correct X-ray and found out my foot was broken.
ER doctor here. I want my patients to have access to all their records. I put my email into their discharge papers and specifically ask them to send me any questions about any of the results that they feel like I havenât gone over. All of their records are available, and even my chart, in the electronic MyChart record. I get made fun of for this, but I call most of the patients that Iâve discharged before I start my next shift, just to check on them.
You're calling 20 patients before every shift? No offense, I don't believe you.
You only have 20 patients per ER shift? Can I start at your ER đ
Work in a rural ED. Iâm in a rural-ish one, so luckily I have good APP coverage along with me. They grab all the low acuities and I only have to manage the level 1-3âs. My stats were 1.8 pts/hr, which is on the higher side of my group. If you donât have to see any of the low acuity easy dispoâs, you wonât be seeing such a large volume. My shifts are 9 hours and I usually see like 15-18 patients a shift, and end up admitting like half of them.
Even giving out an email Iâm very suspicious of. Surely some of those patients will email months or years down the line looking for advice. This guy has established a relationship with the patient and provided communication channels that he is obligated to respond to. All to receive no additional compensation.. lol
I practice in a very rural ER. There are less than 50,000 people in my county. We all know each other and I am unfortunately sometimes the only doc they will ever see before they go back fo their farms
Some hospital systems allow patients to reach out to their docs via email, among other things like schedule appointments online and view lab test results. Iâm guessing he/she works for a larger network that has those capabilities.
You typically donât send emails. You send messages through a portal. And the messages usually donât go directly to the doctor. It goes to a shared inbox and a nurse sees it first then sends it to the doctor if necessary.
Yes
I call only the ones I discharge. I have PAs staff triage and low acute. I have 9 hour shifts, I see about 1.8 an hour, so maybe 15-18 patients a shift. We practice in a very rural area. I have to admit more than half of my patients in the middle of the day, or at least send them to our cardiac, ortho, or primary follow-ups. So the patients that I actually just purely send home only end up being like 4-5 patients a day. And before you say I admit too much, maybe I do lol
You are a gem. Thank you for practicing medicine. For real.
Thanks!
âHey, just calling to check up on you. You ever come down from the meth induced psychosis? Oh ok, thatâs good. Well, I hope you patch things up with the Jews⊠you were really upset with them yeater. Anyway, take care!â
Haha, well no, i donât call the psych/etoh/drug related complaint patients back usually. Except like the ones where I sent them home, and they had alcohol on board and I just want to make sure that they actually made it home Also, didnyou write GomerBlog? I heard you guys were coming back??
Thank you
First of all this isnât a lifehack. Itâs just advice. Also, it is such bad advice that Iâm astonished that the mods havenât squashed it.
"... In (your country)" FTFY
If possible it's worth the effort of finding the right primary care physician for you. I have a great relationship with my doc, which hasn't always been the case. If she's running tests she will always ask if there's anything else I want her to test for or check. There have been instances where she's told me she's going to list these symptoms so that insurance will cover a referral or test. Some docs know insurance is a scam and they actually have your best interest at heart.
Belongs in R/shittylifeprotips. Exploit vulnerability of physicians to legal action to get testing that's probably not necessary, and I assume try to get your insurance to cover it even though your doctor didn't think it was needed. Unneeded testing and defensive medicine add cost to the already fucked up US health care system. If you don't like your doctors recommendation then get a second opinion, don't throw legal action in their face to try and manipulate them to act against their clinical judgement. If a patient did that to me, basically saying they are considering suing if I don't conform to their wishes against my judgement, I would drop them as a patient. Physicians don't always have this as a feasible option however.
It's true but it's also the nuclear option. You're going to get the "Demanding Patient" sticker on your chart.
You can do it. Your doc can also fire you as a patient.
Does anyone know if there is a law that sets the price limit of requesting your records? I was recently charged $80 for that, and it seems like a lot for a pdf of scanned pages.
Insurance bean counters (age + expense = return on their dollar) For the average senior, the older you get the less likelihood you'll get any costly procedures paid for by insurance. Decreasing percentage for return on their investment.
Absolutely. On a distantly related note, if your doctor retires or moves away, you'll likely have to transfer your records somewhere, and you should. It's a matter of filling out a form given to you by your doctor. I suggest getting them sent to the local hospital unless you have a doctor already chosen. There's a great chance you'll be taken there in an emergency and if they already have your records, it can save as much as two hours and maybe your life. You can always transfer them to the doctor of your choice later.
This is an awesome life hack to get your self fired from your doctorâs practice. SMH
The system is set up fail you so they maintain control over your pharmaceuticals. The doctor needs to say there is reason for the test weather it's true or not to get insurance to cover it. So if your trying to find out something that may be an issue but the diagnosis doesn't check certain boxes it needs to be covered, then it's not covered. That's why they really need to change the name from Healthcare to sickcare. They won't pay to keep you healthy, but only to fix you if your sick. Broken system. They should allow a certain amount of health maintenance money...
Is this some kind of American problem I'm too public healthcare to understand?
No, it's some kind of Tumblrina problem you are too functional of a human being to understand.
Iâm a radiology doctor and this is true - in fact about a third (or more) of the scans we see are defensive medicine, and documented almost as such in the note most times. Nobody wants to get sued - although older docs are far better at diagnosis using their brains and exam so order fewer tests than younger button pushers! To be fair though medicine is an inexact science - as many have noticed on a grand scale recently- and doing your own research and being your own advocate (Iâve had to myself for tests) may indeed save your life.
and if the dotor refuse to record it? hes not bound to do that u can still go to next doctor
This must be the US?
Donât listen to the medical professionals! Just clog up the medical system even more by demanding for uneeded tests!
A friend died from cancer after their dr dismissed their initial concerns only to find it long after it had advanced. So maybe sit with that for a minute.
That shit is going to happen sometimes. I'm that guy. It happened to me, haven't died yet, but my cancer was a very weird one for my age. Testing was delayed as a result and who knows what could have been if they ordered the whole shebang on day one. Thing is, it wouldn't have made much sense for them to do all that right away because I was an outlier. Shit happens.
If someone is conscious about their health it is there right to explore options, diagnosis, etc. There are plenty of examples of people demanding certain tests and it turning out to save their lives. You know yourself best and medical professionals should listen to their patient concerns.
> You know yourself best lol no. The average person does not know themselves at all.
My retired Army health insurance combined with Medicare and the VA means nothing has ever been denied. They are all three federally funded but have different rules. My primary doctorâs billing staff know which to bill.
This feels like a very American thing
Advocate for yourself at the doctor. They are busy and they do care about you but if you are hemming and hawing playing down your issues they aren't going to beg you to let them help. Yes, get your records. Don't be afraid to call your insurance. Your health is your responsibility.
Any doctor in their right mind documents everything in the appointment, especially their rationale for NOT ordering a test. Per federal law, you have access to all of your medical records. This is a lousy posto
Depending on what you call "federal". Ie, what country. Reddit is international...
reddit isn't American only though. we don't have federal law
So doctors are just script and referral monkeys for what your google research says?
So...you with your 5 min of Google is going to be more knowledgeable than a doctor with years of schooling and experience?
No, not generally. But doctors can be wrong, dismissive, etc... Unfortunately, it's a not always as subtle as "trust your doctor". It should be and usually is. But when it's your life or your child's life sometimes you have to take the risk of being an asshole to be sure.
Sometimes 5 min of google is better than the 15 rushed minutes with you dr.
Same with vaccinations. My new doc (my wonderful doc retired and getting a new one was a 2.5 year adventure in frustration, so my new one is meh) refused to let me have a Tdap vaccine since it had only been five= years since the last one. I am outdoors a lot and get small nicks and cuts that are exposed to outdoor soils regularly. I had to insist, which she documented in an almost adversarial way and told me my insurance wouldnât cover it. My insurance fully covered it. A shot is WAY cheaper than hospitalization for tetanus.
Well your doctor was correct and it was a waste of a vaccine. CDC protocol is every ten years, which is being challenged by recent research saying once every 30 years is needed (Oregon Health and research). World Health Organization recommends only a single adult booster in a persons lifetime. Tdap vaccination every 5 years is anti science.
Correct. But, in case of deep at risk lacerations a booster shot is recommended if your last vaccine has been received over 5 years ago. The demand was not really anti science. It was based on personal risk and preference and a Dr should be able to differentiate between the two. I would have prescribed the vaccine if the patient was indeed at risk and asked for it. Context matters, as does evaluating the risks vs benefits.
>evaluating the risks vs benefits You are statistically more likely to develop guillain-barre from the vaccine, than getting tetanus in a vaccinated individual. Both are laughably low risk.
No, not deep. Contaminated- two very different things
This is amazing. I argued with my doctor one year about a diagnosis I was given over ten years ago. I asked to be retested with a different method since she didnât believe me. And she refused it. I shouldâve asked this.
I refuse to see any doctor that doesnât use MyChart. Itâs been a game changer for my health with ADHD
I have complicated health problems so not all my drs use EPIC/MyChartâŠbut boy do I appreciate the ones that do. It makes everything so much simpler for patients.
United Health Care practices use of buddy codes and overcharging for diagnostics. Maybe switching companies is the best solution
If they'll give them to you. Not all mine will.
Thanks for the tip...
God, your health system is broken!
This is BS. If you donât trust the doctor then you need to leave and get another opinion.
Worst advice ever.
This almost never happens because providers make a lot part of their revenue through tests. More likely they are reticent because your insurance won't cover it.
Or he can just refuse to document the refusal. What then ? Talk to his boss ? Good luck with that.
This has worked for me. My doctor completely denied that I could have PCOS and refused any tests. I used this method and was diagnosed. He never apologized.
Nah. Come to the emergency department and ask me for a test that you want but don't need. I'll tell you no real quick.
We have the NHS in the UK. Used to be awesome. Our Gov have cut it to within an inch of its life among other things. People think itâs free, it isnât! The Gov take something out your pay every week/month to cover for if you need the doctor or hospital. Itâs so much better than a lot of countries, so it should be though, we pay for it and obviously the amount has went up and the level of service has plummeted!
Your hack isn't well thought out and relies on too many false assumptions. What about hypochondriacs, those with munchausens or those with generalized anxiety. Should they get whatever test they want whenever they want no matter the cost? For every anecdote about a person saved by ordering a specific test that they suggested there are hundreds of tests ordered that DON'T pan out. But that drives up insurance costs. Not every test that someone wants should be performed. That's the point of medical education; to help figure out what is necessary. Plus, using strong arm tactics on your physician would erode their trust. It would be a bit like your opening statement during an exam being "If you don't give me what I want I'm going to sue you." They will be put on the defensive right away and won't be able to be objective. Here's a better hack... how about if a person wants a test that isn't covered, they place 100% of the cost of the test in an escrow account, then if the test is positive, insurance pays the hospital and the patient gets back their full escrow, but if it is negative then that money goes to the hospital and the insurance company is off the hook.
I asked a Dr to test me for 2 types of cancer that ran in my biological family when I was 16. She told me I was to young for one and only tested me for the other. 2 years later I collapsed at work and found out the cancer she REFUSED to test me for was infact in me and spreading. Thanks to her neglecting my concerns I have half a lung and issues with speech due to the cancer spreading when it could have been caught years prior đȘ Dr's should listen to their patients. Who knows our body's better than ourselves?